Barriers and facilitators to implementation of home phototherapy for neonatal hyperbilirubinaemia: Perspectives from healthcare professionals and parents.

Background: Phototherapy for hyperbilirubinaemia in neonates is one of the most frequent causes of hospitalisation in the first week of life, accounting for up to 35 % of hospital (re)admissions. Studies suggest that phototherapy can be applied safely and effectively at home. However, in-hospital phototherapy is still the standard care in most settings.

Aim: We aimed to explore determinants of implementing home phototherapy from the perspectives of healthcare professionals and parents to inform its wider implementation.

Methods: We conducted focus group interviews with healthcare professionals involved in home phototherapy for neonatal hyperbilirubinaemia. In addition, individual interviews were performed with parents of neonates treated with home phototherapy. We used the Consolidated Framework for Implementation Research (CFIR) for identifying determinants to guide data collection and analysis.

Findings: Five focus group interviews with 21 healthcare professionals and 10 semi-structured interviews with parents (10 mothers, eight fathers) were conducted. Barriers concerned the lack of reimbursement options and the challenge to reach all the different healthcare professionals for education. Main facilitators concerned multiple relative advantages of home phototherapy experienced by healthcare professionals and parents such as keeping the family together, the low complexity of home phototherapy, the motivation of parents to perform home phototherapy, the attitude and self-efficacy among healthcare professionals, and the involvement of all key stakeholders from the beginning of the implementation process.

Conclusion: This study identified key barriers and facilitators regarding implementation of home phototherapy for neonatal hyperbilirubinaemia. Based on these findings, tailored implementation strategies can be developed.